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Labs-Findings 2 Flashcards

1
Q

Patient with primary mineralocorticoid exess would have the following serum lab values for sodium, potassium, and bicarbonate?

A

Sodium is normal (aldosterone escape - ANP compensates allowing sodium loss) LOW potasium (due to high aldo) and HIGH BICARB (alkalosis, to secrete hydrogen, bicarb must be reabsorbed?)

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1
Q

Biopsy of breast revelas Solid sheets of pleomorphic, high-grade cells with central necrosis

A

DCIS (comedocarcinoma)

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2
Q

Biopsy of breast revelals increased cytological atypia and stromal cellularity and overgrowth with “leaflike” architecture

A

Phyllodes tumor

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3
Q

Harsh, crescendo-decresendo systolic ejection murmur at right sternal border radiating to carotids

A

AORTIC STENOSIS - BICUSPID AORTIC VALVE is a COMMON CAUSE

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4
Q

Cell body rounding, peripheral displacement of nuclei and dispersion of Nissl substance to periphery of cells of anterior horn of spinal cord

A

AXONAL REACTION - changes in body of neuron after axon is severed. Reflects increased protein synthesis that facilitates axon repair. Visible within 24-48 hours and maximal change at 12 days post injury. Wallerian degeneration.

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5
Q

HUS causes these findings

A

Microangiopathic hemolytic anemia and THROMBOCYTOPENIA - reduced Hb, Ht, RBC count and increased LDH, reticulocytes, Bleeding time increased due to LOSS OF PLATELETS

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6
Q

Large spherule filled with small round endospores found in tissue samples (PIC)

A

Coccidioides immitis

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7
Q

Pulsus paradoxis

A

CARDIAC TAMPONADE - decrease in systolic pressure of 10 mmHg during inspiration compared with pressure during exhalation. (mechanism - pericardial pressure exceeds 10 mmH increasing venous pressure and causes atria to collapse -> reducing ventricular prel

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8
Q

Pulsus parvus et tardus

A

pulse palpaed in patients with AORTIC STENOSIS. Low magnitude with a delayed peak

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9
Q

Amniotic fluid reveals elevatd AFP and acetylcholinesterase

A

NTDs - neural tube fails to fuse causing persistent communication between spinal canala nad amniotic cavity - fetal cerebrospinal fluid leaks out.

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10
Q

Janeway lesions

A

Small, erythematous, hemorrhagic macules appear on soles of feet and hnads, caused by SEPTIC MICROEMBOLI to CUTANEOUS BLOOD VESSELS. Fragements of infected intracardiac vegetations

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11
Q

AFP secreted by these tumors

A

fetal liver and yolk sac normally ,but tumors HCC, nonsemiomatous testiular carcinomas and ovarian carcinomas

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12
Q

You suspect Hypertrophic cardiomyopathy (HCM) how would you enhance this murmur?

A

DECREASE LV END DIASTOLIC VOLUME will increase the obstruction and cause SYSTOLIC EJECTION MURMOR to increase. STAND SUDDENLY from supine and VALSALVA decrease venous return and would accentuate murmor

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13
Q

Maneuvers to increase venticular preload

A

Squatt, sitting, lying supine, passive leg raising increase right and left ventricular preload.

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14
Q

Histological finding in Hashimoto’s thyroiditis

A

Mononuclear, parenchymal infiltration with well-developed germinal centers (Type IV hypersensitivity)

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15
Q

Histology seen in subacute thyroiditis

A

Gde Qervain’s thyroiditis or granulomatous thyroiditis shows MIXED cellular infiltration with occasional multinuclear giant cells.

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16
Q

Serum sodium and urine osmolality after dehydration in DI

A

Urine osmolality 142 mEq/L

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17
Q

Normal urine osmolality after dehydration in healthy individual

A

>800 mOsm/L

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18
Q

Patient undergoes water deprivation test and urine osmolality increases to >500 mOsm/L with serum sodium <10% increase. Diagnosis

A

Primary Polydipsia

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19
Q

Expectorant shows tall, columnar cells that line alveolar septa without evidence of vascular or stromal invation. Lungs show pneumonia-like consolidation

A

bronchioloalveolar carcinoma

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20
Q

Small chain dextrin-like material accumulates within the cytosol of hepatocyte

A

Cori disease (debrnaching enzyme deficiency) alpha-1,6 glucosidic branch points can’t degratde, present with hypoglycemia, hypertriglyceridemia, ketoacidosis, hepatomegaly

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21
Q

Urine of patient in DKA would show a pH, bicarb, and phosphate levels of?

A

Kidneys try to correct via EXCESS H IONS EXCRETED (low pH) CYCLE BICARB (low in urine, releases H+ in exchange for sodium), TITRATABLE ACIDS EXCRETED - binds to HPO4 and NH3 so HPO4 increases

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22
Q

Used as a marker for mast cell activation

A

TRYPTASE

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23
Q

Hyperparakeratosis, acanthosis, rete ridge elongation, mitotic activity above the epidermal basal cell layer, reduced or absent stratum granulosum.

A

Psoriasis (caused by CD4+ T cells that activate CD8+ T cells in epidermis after interacting with APCs in skin)

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24
Thoracocentesis should be performed above these locations
ABOVE 7th rib in midclavicular line, 9th rib along midaxillary line, 11th rib along posterior scapular line. Insertion lower increases risk for penetrating abdominal structures
25
Insert needle inferior margin of rib may damage this structure
NEUROVASCULAR BUNDLE - intecostal vein, artery, and nerve lie in the SUBCOSTAL groove on the LOWER border of the rib. INSERT AT UPPER BORDER
26
Ability to clot blood plasma distinguishes these species
Coagulase test separates Staphylococci into 2 groups: Coagulase positive (S. aureus) and coagulase negative (CNS) including S. epidermidis, S. haemolytius, S. saprophyticus, and 30+ other species
27
3% hydrogen peroxide differentiates
Catalase - Streptococci from Staphylococci
28
Can staphylococci ferment mannitol?
Only S. aureus can ferment mannitol
29
Common lab finding in SLE (Complete Blood count)
Pancytopenia - formation of autoantibodies against RBCs, a type II hypersensitivity
30
early systolic, high-frequency click over cardiac apex and/or right second interspace
Nonstenotic bicuspid aortic valve
31
Neurons that display signs of irreversible damage during the first 48 hours
Red neruons
32
Mechanism of ischemic infarct of brain at 3-5 days
MACROPHAGES (MICROGIA) move to ischemic area and phagocytize framgnets of neurons, myelin, an dnecrotic debris. Cystic space replaces necrosis, astrocytes form glical scar along periphery
33
Polyribitol phosphate
Type B Haemophilus
34
Raised, reticular cyanotic discoleration consistent with livedo reticularis, P-anca, Foot drop
Chrurg-Strauss syndrome (Small vessel vasculitis)
35
Polyglutamic acid capsule
Bacillus Anthracis - the only bacterium with a POLYPEPTIDE CAPSULE (contains D-glutamate)
36
Mold form contains barrel-shaped arthroconidia
Coccidioides immitis
37
Gram (+), spore forming bacilli and widening of the mediastium
Bacillus anthracis with polyglutamic acid capsule
38
Most sensitive test for iron deficiency anemia
Low serum ferritin
39
Dark, intracellular inclusions that stain with crystal violet
Heniz bodies strongly associatd with G6PD deficiency, represent Hb that is denatured/precipitated from oxidative stress
40
Fractured 12th rib could injure which structure?
Left kidney lies immediately deep to the tip of the 12th rib on the left
41
CXR shows unilateral pulmonary opacification and deviation of the mediastinum toward the opacified lung
Obstructive lesion of mainstem bronchus can prevent ventilation of entire lung, leading to collapse. Trachea will deviate TOWARDS the OPACIFIED LUNG with VOLUME LOSSS (atelectasis)
42
Direction of trachea
TOWARD volume loss (atelectasis) and AWAY from opacified lung with a large pleural effusion.
43
Type of cells observed in infectious mononucleosis?
Atypical lymphocytes are activated CD8+ cytotoxic T-lymphocytes. Destroy virally-infected B-lymphocytes
44
RPR or VDRL
Screening test for treponema pallidum, confirmatory test is known as FTA-ABS
45
RPR test
Rapid plasma reagin tests - detects antibodies to human cellular lipids released into the bloodstream after cell destruction by T. pallidum
46
Cold agglutinins positive
MYCOPLASMA infection - patient blood is added to tube pretreate with anticoagulant EDTA and then placed on ice. RBCs agglutinate at low temp and return into suspension when warmed.
47
185 kD glycoprotein that spans the cell membrane with intracellular tyrosine kinase activity
HER2/neu oncogene encodes this glycoprotein, member of epidermal growth factor receptors. Overexpression accelerates cell proliferation
48
More than 10% increase in urine osmolality following vasopressin administration during water deprivation test
CENTRAL D, if urine osmolality increase above 50%, COMPLETE central DI
49
Most characteristic biochemical feature of Huntington disease
Decreased GABA in brain (los of GABA-containing neurons in the striatum)
50
marker of total rate of endogenous beta-ell insulin secretion under steady-state
C peptide (beta cell peptidases remove from proinsulin to leave mature insulin - B chain and A chain connected via disulfide bonds)
51
Oral hypoglycemic agent that stimulates insulin release
SULFONYLUREAS - ie Glyburide
52
2 oral hypoglycemic agents that inrease the sensitivity of insulin on target issues to insulin
Metformin (a biguanide) and rosiglitazone (thiazolidendione)
53
Associations with a positive Coombs test
Autoimmune hemolytic anemia that often accompanies SLE, Hodgkin, NH lymphomas, Mycoplasma, infectious mono
54
Increased LDH, increased UCB, MCHC \>36 g/dL, pigmented gallstoes, negatvie coombs
Positive osmotic fragility test - HEREDITARY SPHEROCYTOSIS
55
Xanthochromia
Blood in the CSF, most sensitive test for diagnosing SAH
56
Karyotype of 46XX or 46XY with enlarged edematous villi and trophoblastic proliferation "Bunch of grapes"
Complete mole with 15-20% risk of malignant trophoblastic disease
57
Cells scraped from an ulcer base are stained with a solution and demonstrate intranuclear inclusions
Tzanck prep using Wright-Giemsa staining of epithelial cells, multinucleated giant cells with intranuclear inclusions suggest HSV or VZV infection
58
Is peripheral edema seen in SIADH
NORMAL TOTAL BODY VOLUME (euvolemic hyponatremia) due to suppression of renin-aldosterone axis, casuing low aldosterone causing natriuresis (salt-wasting via urine)
59
Low plasma sodium osmolality, concentrated urine, increased sodium in urine, normal body volume
SIADH
60
Serum sodium 120 mEq/L + Urine osmolality 360 mOsm/kg
SIADH
61
Serum sodium 120 mEq/L + Urine osmolality \<100 mOsm/kg
PRIMARY POLYDIPSIA
62
"Satellite phenomenon"
H influenzae grow only near beta hemolytic S aureus because they produce the needed X(hematin) and V (NAD+) factors for growth. H. influenza is "blood loving" organism
63
Gout results from deposition of
MONOSODIUM URATE in joints and soft tissue - needle-shaped and negatively birefringent
64
Mid-diastolic rumble hear best at apex, scattered cells within mucopolysacchride stroma, abnormal blood vessels, hemorrhaging
ATRIAL MYXOMA - mos common primary cardiac neoplasm
65
4 year old with 5 day fever, n/v, bilateral conjunctivitis, bright red tongue with cracked lips, desquamation involving skin on fingertips. Most at risk for?
Kawasaki - coronary artery aneurysms (medium sized vessel vasculitis)
66
CXR diffuse thickening and fibrosis of lower lung lobes with formation of fibrocalcific plaques on parietal plerua. Fibers coated with a protein-iron matrix
Ferruginous bodies seen in Asbestosis - formation of fibrocalcific plaques on parietal pleura with fibrosis of lower lung lobes
67
How to assess comprehension?
Following MULTI-STEP COMMANDS
68
How to asses Attention and Concentration
RECITE months or year backwards; Count down from 100 by 7 or 3s, spell world backward
69
How to asses short-term memory
Recall 3 unrelated words after 5 minutes
70
Components of MSE
Orientation-Comprehension-Concentration-Memory(S/L)-Language-Visual-spacial (Oriental californians Can memorize languages visually)
71
Dysplasia
Reversible change in epithelial cells (not reversible once invasive cells breach BM)
72
GnRH, LH, and testosterone levels in a patient with bitemporal hemianopsia
Pituitary tumor 605 of time is prolactinoma and PROLACTIN INHIBITS ENTIRE AXIS of GnRH-LH/FSH - sex hormones - causing impotence in men, amenorrhea in women (hypogonadotropic amenorrhea)
73
Grossly, deposits of fine gritty white granules or clumps. HE show deposits that are dark purple, sharp-edged aggregates. Psammoma body if lamellated outer layers
DYSTROPHIC CALCIFICATION
74
NORMAL CHEST RADIOGRAPH - SHOW RIGHT ATRIUM - RIGHT VENTRICLE
Right border is RA, center is RV, lower left border is LV
75
Microscopic findings: Eosinophilic intranuclear inclusions in multinuclear squamous cells at margins of ulcers (espophageal biopsy of HIV patient)
HSV-1
76
Microscopic findings: Both intranuclear and cytoplasmic inclusions from esophageal biopsy of aids patient
CMV
77
Arterial blood findings in 32 year old female: PaO2 Normal, 5 Saturation normal, Oxygen content is low
Chronic blood loss - total oxygen content is determined by amoung of Hb in blood and its percent saturation
78
Pulsus paradoxus
Decreased in systolic BP greater than 10 mmHg with inspiration
79
What causes the decrease in systolic blood pressure during inspiration seen in pulsus paradoxus
Expansion of right side of heart imparied and inspiration pushes the IV septum toward the left, left diastolic volume and SV reduced resulting in decreased systemic blood pressure
80
Causes of pulsus paradoxus
Acute cardiac tamponade, constrictive pericarditis, severe obstructive lung disease, restrictive cardiomyopathy
81
Bilateral wedge-shaped bands of necrosis over cerebral convexity, just lateral to interhemispheric fissuure
ISCHEMIC-HYPOXIC ENCEPHALOPATHY
82
Metabolic alkalosis with urinary chloride \<10 mEq/L
SALINE-RESPONSIVE metabolic alkalosis - due to vomiting and nasogastric suction losing hydrochloric acid, associated with volume loss and corrected w volume repletion
83
Metabolic alkalosis with urinary chloride \>20 mEq/L
SALINE-RESISTANT metabolic alkalosis, seen in primary hyperaldosteronism, aldosterone losses K, Cl and H with relative increase in HCO3 resulting from the H losses.
84
High arterial blood pH, HCO3 and pCO2? Major causes?
Metabolic alkalosis - vomiting, NG suction, diuretic use or hyperaldosteronism. Measure urinary chloride and volume status to determine cause.
85
Fine-needle aspiration of thyroid nodule shows spindle-shaped cells in amporphous background, elevated calcitonin
Medullary thyroid are tumors of parafollicular calcitonin secreting C-cells, 80% are sporadic and 20% familial (MEN2) RET proto-oncogene mutation in \>95%!!
86
Vegetations seen in infective endocarditis represent
FIBRIN and PLATELET DEPOSITION at the site of acterial colonization
87
Histology seen in giant cell arteritis
GRANULOMATOUS INFLAMMATION OF THE MEDIA. Also seen in Takayasu arteritis affecting aortic arch
88
ST elevation in leads I and V3-V6
ANTEROLATERAL LEFT VENTRICULAR infarction - LV failure, leading to cardiogenic acute pulmonary edema and transudate of plasma into the lung interstitium and alveoli
89
Hemosiderin-containing macrophages in alveoli
(siderophages) suggest prior episodes of pulmonary congestion = CHRONIC LEFT HF
90
Elevated lactic acid in a patient with fever, leukocytosis, hypotension, tachycardia
SEPTIC SHOCK
91
Lactic acidosis
Anion-gap metabolic acidosis
92
Fever, Leukocytosis + CXR demonstrate dense airspace opacities in the superior region of the lower lobes
most consitent with PNEUMONIA (aspiration likely due to superior regions of lower lobes)
93
Name 2 curved motile gram-negative, oxidase positive rods. How do you distinguish the 2?
Vibrio cholerae GROWS on ALKALINE enrichment media (that kills most organisms of gut). Campylobacter jejuni CANNOT SURVIVE in ALKALINE enrichement.
94
Outbreak caused by oxidase-positive, gram-negative, comma-shaped rods that can survive on alkaline media.
Vibrio cholerae -\> Mucus with some epithelial cells in stool (NO leukocytes or RBCs b/c non-invasive)
95
28 year old woman, shortness of breath, hemoptysis, abnormal vaginal bleeding 8 weeks post partum. Enlarged uterus, elevated human chorionic gonadotrophin (beta-hCG). CXR multiple, bilateral lung nodules
GESTATIONAL CHORIOCARCINOMA - malignant tumor from trophoblast, usually after evacuated hydatidiform mole. Lungs most common site mets.
96
Histology of gestational choriocarcinoma
intrauterine mass that is soft and yellow-white with extesnsive areas of necrosis and hemorrhage. Abnormal proliferation of cytotrophoblasts and syncytiotrophoblasts. No villi.
97
Peaked T waves
serum K concentration \> 6.0 mEq/L (potential for fatal ventricular arrhythmia)
98
squamous metaplasia of epithelial lining of pancreatic exocrine ducts to a keratinizing epithelium
Avitaminosis A
99
Cells with abundant mucin droplets that push the nucleus to one side.
SIGNET-RING or DIFFUSE CARINOMA - diffuse involvment of the stomach wall "leather-bottle stomach" linitis plastica

UWorld FACTOIDs (10 decks)

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